Provider Demographics
NPI:1164868162
Name:SPINE & PAIN ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SPINE & PAIN ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-705-4695
Mailing Address - Street 1:1716 E HUNDRED RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3301
Mailing Address - Country:US
Mailing Address - Phone:804-681-0177
Mailing Address - Fax:804-681-0747
Practice Address - Street 1:1716 E HUNDRED RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3301
Practice Address - Country:US
Practice Address - Phone:804-681-0177
Practice Address - Fax:804-681-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty